Treating Complex Wounds, Gas Gangrene

July 21, 2017

Track 1: Wound Care
Thursday, July 27
10–11:30 a.m.
Tennessee C

Successfully managing wounds using split thickness grafts and learning to diagnose and treat gas gangrene will be examined Thursday during a Wound Care track.

Split Thickness Grafts

Treatment advances can come at a price. For the use of synthetic skin grafts, the price may have to be paid out of a patient’s pocket because insurance does not cover the use of synthetics. A reliable option is to use an established treatment covered by insurance—split thickness wound grafts.

“The focus will be on managing diabetic wounds and other complicated wound sites for patients who have otherwise failed all other measures,” said Joshua Moore, DPM, clinical assistant professor of surgery and assistant dean of educational affairs at Temple University School of Podiatric Medicine. “You should not be afraid of being aggressive surgically with these complicated wounds.”

In “Split Thickness Skin Grafts in Wound Care,” Dr. Moore will use a case study of a patient with diabetes to demonstrate management techniques, starting with diagnosis and continuing through surgery, healing, and post-operative follow-up.

“Recovery requires being absolutely non-weight bearing until the wound is healed,” Dr. Moore said. “If the patient is a healthy person, it is one thing, but if the patient has diabetes, you need to be strict. You need to have weekly check-ups."

Gas Gangrene

Gas gangrene is a bacterial infection that produces gas in the tissues. Its victims face emergency surgery, a long period of healing, possible amputation, and even death. In her presentation, “Gas Gangrene,” Kimberlee Hobizal, DPM, MHA, will explain how to identify the condition, which organisms cause it, and how to treat it.

Dr. Hobizal, of ASP Orthopedics and Sports Medicine, Beaver, PA, will examine treating patients in an acute setting using operative debridements and in a chronic setting using routine wound care. Using case studies from her practice, she will walk through a diagnosis, physical exam, diagnostic imaging, surgical intervention, and follow-up treatment.

Gas gangrene is the result of a progressive buildup of gas in tissue that leads to necrosis. The gas-causing bacteria come in several forms, but the most common is the clostridium perfringens bacteria.

About 1,200 cases of gas gangrene are diagnosed annually in the United States, and the majority are in the lower extremities, most often from a wound that was not addressed in a timely manner. Often, it is a wound that is chronic in nature or has extended to the bone.

“First and foremost, the patient must be taken to the operating room and an extensive operative debridement needs to be done to salvage the limb. It is a very serious infection, and it can be deadly,” Dr. Hobizal said. “Typically, we see the wound on the bottom of the foot because that is the area that is exposed to most pathogens. Most commonly, it is in patients who have neuropathy.”

Patients with gas gangrene often have multiple comorbidities and are unaware of the wound because they lack feeling in the lower extremities. The wound is commonly discovered when it emits a foul odor.

Healthy patients can develop gas gangrene from an injury, such as a wound on the foot that occurs while swimming in a river or a lake.

“Surgery is really the only option,” Dr. Hobizal said. “If the X-ray shows any type of emphysema or gas bubbles, that is a red flag saying this patient needs to go to the operating room urgently, probably within two hours.

“Treatment is usually debridement and excision, with amputation in some cases where the infection is extensive. Post-operatively, antibiotics specific to the pathogen are needed.”

A hospital stay of five to seven days is common because the patient often needs multiple debridements and wound cultures, Dr. Hobizal said. His or her labs need to be monitored, and wound care is needed after the infection is eradicated.

“The big takeaway from this is the importance of understanding the urgency of the situation. Gas gangrene is a surgical emergency. The faster it is recognized, the better the prognosis is for the patient.”

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